Organization
LEGACY HEALTHCARE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM JOHNSON (OWNER)
(423) 478-5953
Entity
Organization
Contact information
Practice address
600 BACON ST, MADISONVILLE, TX 77864-2511
(936) 348-9097
(936) 348-9212
Mailing address
485 CENTRAL AVE NE, CLEVELAND, TN 37311-5541
(423) 478-5953
(423) 472-6283
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
116849
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5342
—
TX
Enumeration date
07/27/2006
Last updated
08/22/2020
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